Interspinous Process Distraction Technique 83 Recapitulation 84 KeyArticles 85 References 86 4 Age-Related Changes of the Spine Atul Sukthankar, Andreas G. Nerlich, Günther Paesold CoreMessages 91 Epidemiology 91 CaseIntroduction 92 GeneralAge-RelatedChanges 92 FunctionalSpineUnit 93 The Intervertebral Disc and Cartilage Endplate 95 IntervertebralDisc 95 TheCartilageEndplate 107 TheFacetJoints 109 NormalAnatomy 109 Age-Related Changes . 109 VertebralBodies 110 NormalAnatomyandComposition 110 Age-Related Changes . 110 SpinalLigaments 111 NormalAnatomyandComposition 111 Age-Related Changes . 111 SpinalMuscles 112 NormalAnatomyandStructure 112 Age-Related Changes . 112 Recapitulation 114 KeyArticles 115 References 116 5 Pathways of Spinal Pain HeikeE.Künzel,NorbertBoos CoreMessages 123 HistoricalBackground 123 PrecartesianTheories 123 CartesianTheory 124 GateControlTheory 124 ModernPainTheories 124 EpidemiologyofChronicPain 125 Definition and Classification . . 125 TemporalCourse 126 ContemporaryPainClassification 126 PathwaysofPain 128 Transduction 129 Conduction 130 TransmissionandModulation 130 PainProjection 133 PainPerception 134 Neuroplasticity 135 PeripheralSensitization 135 TranscriptionalDRGChanges 136 CentralSensitization 136 Disinhibition 137 Endogenous and Environmental Influences onPainPerception 137 ClinicalAssessmentofPain 138 Differentiating Inflammatory and Neuropathic Pain 138 GeneralConceptsofPainTreatment 141 PharmacologicalTreatment 141 Non-pharmacological Treatment of Spinal Pain 143 BiopsychosocialInterventions 143 SurgicalTreatment 144 Recapitulation 144 KeyArticles 145 References 146 6 Epidemiology and Risk Factors of Spinal Disorders Achim Elfering, Anne F. Mannion CoreMessages 153 GeneralScope 153 ObjectivesinSpinalDisorders 154 ClassificationofSpinalDisorders 155 Etiology 155 TimeCourse 155 LowBackPain 156 NeckPain 157 Pain,ImpairmentandDisability 157 BurdenofSpinalDisorders 159 EconomicCosts 159 RiskFactors 161 IndividualRiskFactors 161 MorphologicalRiskFactors 162 PsychosocialFactors 162 OccupationalPhysicalRiskFactors 163 OccupationalPsychologicalRiskFactors 163 Absence of Evidence for Certain Risk Factors 164 GeographicalVariation 164 FlagSystemfortheRiskFactors 165 RedFlags 165 YellowFlags 166 BlueFlags 166 BlackFlags 166 Direction for Future Epidemiological Research 167 Recapitulation 167 KeyArticles 168 References 169 7 Predictors of Surgical Outcome Anne F. Mannion, Achim Elfering CoreMessages 175 Epidemiology 175 OutcomeMeasures 179 What Constitutes a “Successful Outcome” . . . 180 XIV Contents The Outcome of Common Spine Surgical Procedures 182 PredictorsofOutcomeofSpinalSurgery 183 MedicalFactors 184 BiologicalandDemographicVariables 186 HealthBehavioralandLifestyleFactors 187 PsychologicalFactors 187 SociologicalFactors 189 Work-RelatedFactors 189 Risk Factor Assessment in Clinical Practice . . . 190 Recapitulation 192 KeyArticles 193 References 194 Patient Assessment 8 History and Physical Examination Cl´ement M.L. Werner, Norbert Boos CoreMessages 201 Epidemiology 201 CaseIntroduction 202 History 203 Pain 204 Function 210 SpinalDeformity 210 PhysicalExamination 211 Walking 211 Standing 211 Sitting 216 LyingSupine 220 LyingonLeft/RightSide 220 LyingProne 221 AbnormalIllnessBehavior 221 Reproducibility 221 Differential Diagnosis of Spinal Pain Syndromes 222 Recapitulation 222 KeyArticles 223 References 224 9 Imaging Studies Marius R. Schmid, Jürg Hodler CoreMessages 227 ImagingMethods 227 StandardRadiographs 227 MagneticResonanceImaging 229 ComputedTomography 241 AdditionalImagingMethods 244 Indications for Spinal Imaging 247 Acute Low Back Pain Without Radicular Symptoms,WithoutTrauma 247 Acute Low Back Pain With Radicular Symptoms 248 Spinal Cord and Cauda Compression Syndromes 249 AcuteTrauma 249 ChronicLowBackPain 251 PostoperativeImaging 251 Whiplash-AssociatedDisorders 252 PainRelatingtotheSacroiliacJoint 253 DiseaseoftheSpinalCord 255 Recapitulation 255 KeyArticles 256 References 257 10 Spinal Injections Massimo Leonardi, Christian W. Pfirrmann CoreMessages 261 RationaleforSpinalInjections 261 LumbarandCervicalNerveRootBlocks 262 Indications 262 Technique 263 Complications 265 DiagnosticandTherapeuticEfficacy 265 EpiduralandCaudalBlocks 267 Indications 267 Technique 268 Complications 268 TherapeuticEfficacy 268 ProvocativeDiscography 271 Indications 271 Technique 272 Complications 273 DiagnosticEfficacy 273 FacetJointBlocks 275 Indications 275 Technique 276 Complications 277 DiagnosticandTherapeuticEfficacy 278 SacroiliacJointBlocks 280 Indications 280 Technique 280 Complications 280 DiagnosticEfficacy 281 ContraindicationsforSpinalInjections 281 AlgorithmforSpinalInjections 282 Recapitulation 283 KeyArticles 284 References 285 11 Neurological Assessment in Spinal Disorders Ut a Kliesch, Armin Curt CoreMessages 291 Epidemiology 291 CaseIntroduction 292 AnatomyandSomatotopicBackground 294 Classification 295 NeurologicalAssessment 298 Pain 298 Contents XV SensoryDeficits 298 MotorDeficits 299 ReflexDeficits 299 GaitDisorders 301 BowelandBladderDysfunction 303 DisordersoftheAutonomicSystem 303 SpinalCordInjury 304 SpinalCordSyndrome 304 DifferentialDiagnosis 306 Differentiation of Central and Peripheral Paresis 306 Differentiation of Radicular and Peripheral NerveLesions 306 Differential Diagnosis of Spinal Cord CompressionSyndromes 311 MiscellaneousDifferentialDiagnoses 311 Recapitulation 312 KeyArticles 313 References 314 12 Neurophysiological Investigations Armin Curt, Uta Kliesch CoreMessages 319 HistoricalBackground 319 Neuroanatomy 320 NeurophysiologicalModalities 321 Electromyography 321 NerveConductionStudies 322 F-WaveRecordings 324 H-Reflex 325 SomatosensoryEvokedPotentials 326 Motor Evoked Potentials (Transcranial MagneticStimulation) 328 IntraoperativeNeuromonitoring 329 Role of Neurophysiology in Specific Disorders 330 SpinalCordInjury 330 Cervical/LumbarRadiculopathy 330 CervicalMyelopathy 331 LumbarSpinalCanalStenosis 331 NeurophysiologyinDifferentialDiagnosis 332 Peripheral Nerve Lesion Versus Radiculopathy 332 Neuropathy Versus Spinal Canal Stenosis . . . 332 MyopathyandMyotonicDisorders 333 Hereditary and Neurodegenerative Disease . 333 Recapitulation 334 KeyArticles 334 References 335 13 Surgical Approaches Norbert Boos, Claudio Affolter, Martin Merkle, Frank J. Ruehli CoreMessages 337 Surgery and Planning . . . 337 Anterior Medial Approach to Cervical Spine . . . 337 Indications 338 Patient Positioning . . . 338 SurgicalExposure 339 PitfallsandComplications 341 PosteriorApproachtotheCervicalSpine 342 Indications 342 Patient Positioning . . . 342 SurgicalExposure 343 PitfallsandComplications 345 Right-SidedThoracotomy 345 Indications 346 Patient Positioning . . . 346 SurgicalExposure 346 PitfallsandComplications 349 Left-SidedThoraco-Phrenico-Lumbotomy 350 Indications 350 Patient Positioning . . . 350 SurgicalExposure 350 PitfallsandComplications 353 Anterior-Lateral Retroperitoneal Approach toL2–L5 353 Indications 353 Patient Positioning . . . 353 SurgicalExposure 353 PitfallsandComplications 355 Anterior Lumbar Retroperitoneal Approach . . . 355 Indications 355 Patient Positioning . . . 355 SurgicalExposure 356 PitfallsandComplications 358 Posterior Approach to the Thoracolumbar Spine 358 Indications 358 Patient Positioning . . . 358 SurgicalExposure 359 PitfallsandComplications 361 LandmarksforScrewInsertion 361 Cervico-occipitalSpine 361 Recapitulation 368 KeyArticles 369 References 369 Peri- and Postoperative Management 14 Preoperative Assessment Stephan Blumenthal, Youri Reil and, Alain Borgeat CoreMessages 373 AimofPreanestheticEvaluation 373 InformationandInstructions 374 PatientAssessment 374 History 374 PhysicalExamination 375 LaboratoryStudies 375 XVI Contents Organ-SpecificAssessment 376 AirwayAssessment 376 RespiratorySystem 376 CardiovascularAssessment 378 NeurologicalAssessment 379 PerioperativeDrugTherapy 379 WhattoStop,toContinueandtoAdd? 379 Premedication 380 ThromboembolicProphylaxis 380 Special Conditions Requiring Spinal Surgery . . 382 SpinalDeformity 382 NeuromuscularDisease 383 CerebralPalsy 383 Malignancy 384 SpinalCordInjury 384 Recapitulation 385 KeyArticles 386 References 387 15 Intraoperative Anesthesia Management Juan Francisco Asenjo CoreMessages 389 HistoricalBackground 389 GoalsofAnesthesiainSpinalSurgery 389 PreoperativePatientAssessment 390 InductionofAnesthesia 390 Airway Control and Endotracheal Intubation 391 AntibioticProphylaxis 393 Patient Positioning . . . 394 MaintenanceofAnesthesia 396 IntraoperativeMonitoringTechniques 397 AdvancedMonitoringofVitalFunctions 397 Monitoring Depth of Anesthesia (Consciousness) 400 Intraoperative Blood Preserving Techniques . . . 400 ControlledHypotensiveAnesthesia 401 IntrathecalOpiates 402 Blood Predeposit and Erythropoietin Injection 402 CellSalvage 402 PharmacologicalMeasures 403 Blood Transfusion and Coagulation Factor Substitution 403 IntraoperativeSpinalCordMonitoring 405 AnestheticEffectsonSSEPs 406 AnestheticEffectsonMEPs 407 NerveRootMonitoring 408 Wake-upTest 408 EndofAnesthesia 409 PostoperativePainManagement 409 Recapitulation 411 KeyArticles 411 References 412 16 Postoperative Care and Pain Management Stephan Blumenthal, Alain Borgeat CoreMessages 417 PostoperativeCare 417 PostoperativeVentilationorExtubation 418 HemodynamicAssessment 419 NeurologicalAssessment 419 GastrointestinalFunction 420 ThromboembolicProphylaxis 420 PostoperativePainManagement 420 ConsequencesofPain 420 Non-narcotics 421 Non-steroidalDrugs 421 Opioids 421 LocalAnesthetics 422 N-Methyl- D-aspartateAntagonists 422 Recapitulation 423 KeyArticles 423 References 424 Degenerative Disorders 17 Degenerative Disorders of the Cervical Spine Massimo Leonardi, Norbert Boos CoreMessages 429 CaseIntroduction 430 Epidemiology 430 Pathogenesis 432 NeckPain 432 CervicalDiscHerniation 432 CervicalSpondyloticRadiculopathy 433 CervicalSpondyloticMyelopathy 433 ClinicalPresentation 435 History 436 PhysicalFindings 437 FunctionalAssessment 439 DiagnosticWork-up 439 ImagingStudies 439 NeurophysiologicalAssessment 444 DifferentialDiagnosis 444 Non-operativeTreatment 444 NaturalHistory 445 ConservativeTreatmentModalities 446 OperativeTreatment 448 GeneralPrinciples 448 SurgicalTechniques 449 CaseStudy1 451 CaseStudy2 454 CaseStudy3 456 SurgicalDecision-Making 459 Complications 463 Recapitulation 464 KeyArticles 466 References 468 Contents XVII 18 Disc Herniation and Radiculopathy Massimo Leonardi, Norbert Boos CoreMessages 481 Epidemiology 481 CaseIntroduction 482 Pathogenesis 483 RiskFactors 483 Radiculopathy 484 ClinicalPresentation 486 History 486 PhysicalFindings 487 DiagnosticWork-up 488 ImagingStudies 488 NeurophysiologicAssessment 490 UrologicAssessment 490 DifferentialDiagnosis 491 Classification 491 Non-operativeTreatment 493 NaturalHistory 494 ConservativeMeasures 494 OperativeTreatment 496 GeneralPrinciples 496 CaseStudy1 497 SurgicalTechniques 497 CaseStudy2 499 Conservative Versus Operative Treatment . . . 503 Complications 504 Recapitulation 505 KeyArticles 506 References 507 19 Lumbar Spinal Stenosis Patrick O. Zingg, Norbert Boos CoreMessages 513 Epidemiology 513 CaseIntroduction 514 Pathogenesis 515 Anatomy 515 Pathogenesis 515 SpinalClaudicationSyndrome 517 Classification 517 ClinicalPresentation 519 History 519 PhysicalFindings 520 DiagnosticWork-up 520 ImagingStudies 520 NeurophysiologicStudies 523 DifferentialDiagnosis 524 Non-operativeTreatment 524 NaturalHistory 525 Non-operativeOptions 525 OperativeTreatment 526 GeneralPrinciples 526 SurgicalTechniques 526 CaseStudy1 527 CaseStudy2 529 OperativeRisksandComplications 530 Recapitulation 531 KeyArticles 532 References 533 20 Degenerative Lumbar Spondylosis Martin Merkle, Beat Wälchli, Norbert Boos CoreMessages 539 Epidemiology 539 CaseIntroduction 540 Pathogenesis 541 Disc Degeneration and Discogenic Back Pain 542 FacetJointOsteoarthritis 543 SegmentalInstability 544 ClinicalPresentation 545 History 546 CaseStudy1 547 PhysicalFindings 548 DiagnosticWork-up 548 ImagingStudies 549 CaseStudy2 550 InjectionStudies 551 TemporaryStabilization 552 PatientSelectionforTreatment 552 Non-operativeTreatment 553 OperativeTreatment 554 GeneralPrinciples 554 BiologyofSpinalFusion 555 SurgicalTechniques 558 ComparisonofTreatmentModalities 568 Complications 569 Recapitulation 570 KeyArticles 571 References 573 21 Non-specific Low Back Pain Florian Brunner, Sherri Weiser, Annina Schmid, Margareta Nordin CoreMessages 585 Epidemiology 585 CaseIntroduction 586 ClassificationofBackPain 587 PathogenesisofNSLBP 587 Patient Assessment and Triage for Non-operative Treatment 588 ManagementofNSLBP 590 Management of Acute NSLBP (<4 weeks) . . . 590 Management of Subacute NSLBP (4–12 weeks) 592 Management of Chronic Non-specific LBP (>12weeks) 595 Recapitulation 596 XVIII Contents KeyArticles 596 References 598 22 Postoperative Rehabilitation Florian Brunner, Shira Schecter-Weiner, Annina Schmid, Rudolf Kissling CoreMessages 603 Epidemiology 603 ConceptionalBackground 604 TheoreticalConsiderations 604 AnatomicalandSurgicalConsiderations 605 IndividualandSocietalConsiderations 606 Indications for Postoperative Spinal Rehabilitation 606 GeneralGoals 607 SpecificGoals 607 PrinciplesofPostoperativeRehabilitation 607 PreoperativeAssessment 607 PostoperativeRehabilitation 608 ObstaclesforRehabilitation 616 Morphological Obstacles and General Medical Obstacles 616 PsychosocialObstacles 617 Work-RelatedObstacles 617 Recapitulation 617 KeyArticles 618 References 619 Spinal Deformities and Malformations 23 Idiopathic Scoliosis Mathias Haefeli, Kan Min CoreMessages 623 Epidemiology 623 CaseIntroduction 624 Pathogenesis 625 GeneticFactors 625 Connective Tissue and Skeletal Muscle Abnormalities 625 Thrombocyte Abnormalities, Calmodulin andMelatonin 626 Classification 626 Age-RelatedClassification 626 RadiologicalClassification 627 ClinicalPresentation 627 History 627 PhysicalExamination 629 DiagnosticWork-up 632 ImagingStudies 632 NeurophysiologicEvaluation 637 Treatment 637 GeneralConsiderations 637 NaturalHistory 637 Non-operativeOptions 639 OperativeTreatment 641 IndicationsforSurgery 641 GeneralPrinciples 642 CaseStudy1 646 SurgicalDecisionMaking 647 CaseStudy2 651 Complications 651 Recapitulation 652 KeyArticles 653 References 654 24 Neuromuscular Scoliosis Jean A. Ouellet , Vincent Arlet CoreMessages 663 Epidemiology 663 CaseIntroduction 664 DiseaseSpecificSpinalDeformity 666 Pathogenesis 667 Classification 667 ClinicalPresentation 669 History 669 PhysicalExamination 670 CaseStudy1 671 DiagnosticWork-up 673 MedicalAssessment 673 CaseStudy2 674 ImagingStudies 675 Non-operativeTreatment 677 NaturalHistory 677 Non-operativeTreatmentOptions 678 OperativeTreatment 678 SurgicalIndications 678 GeneralPrinciples 679 SurgicalTechniques 680 CaseStudy3 680 CaseStudy4 686 Recapitulation 689 KeyArticles 690 References 691 25 Congenital Scoliosis Francis H. Shen, Vincent Arlet CoreMessages 693 Epidemiology 693 CaseIntroduction 694 Pathogenesis 694 Classification 695 ClinicalPresentation 696 History 696 PhysicalFindings 697 DiagnosticWork-up 698 ImagingStudies 698 SpecificInvestigations 700 Non-operativeTreatment 700 Contents XIX NaturalHistoryandProgression 700 OperativeTreatment 701 GeneralPrinciples 701 SurgicalTechniques 702 CorrectiveSurgeryProcedures 702 CaseStudy1 703 CaseStudy2 704 MiscellaneousSurgicalTechniques 707 Recapitulation 708 KeyArticles 709 References 710 26 Degenerative Scoliosis Max Aebi CoreMessages 713 Epidemiology 713 CaseIntroduction 714 Pathogenesis 715 Classification 716 ClinicalPresentation 717 History 717 PhysicalFindings 719 DiagnosticWorkup 720 ImagingStudies 720 InterventionalRadiologicalProcedure 721 AdditionalDiagnosticTools 722 Non-operativeTreatment 722 OperativeTreatment 723 DecompressionProcedure 724 CorrectionProcedures 724 SurgicalTechniques 725 CaseStudy1 728 CaseStudy2 729 Recapitulation 729 KeyArticles 730 References 731 27 Spondylolisthesis ClaytonN.Kraft,RüdigerKrauspe CoreMessages 733 Epidemiology 733 CaseIntroduction 734 Pathogenesis 735 Classification 735 ClinicalPresentation 736 History 736 PhysicalFindings 738 DifferentialDiagnosis 738 DiagnosticWork-up 739 Imaging 739 CaseStudy1 742 InvasiveImagingStudies 743 Non-operativeTreatment 745 NaturalHistory 745 ConservativeTreatmentOptions 745 OperativeTreatment 747 GeneralPrinciples 747 SurgicalTechniques 748 CaseStudy2 751 Complications 756 Recapitulation 757 KeyArticles 758 References 759 28 Juvenile Kyphosis (Scheuermann’s Disease) Dietrich Schlenzka, Vincent Arlet CoreMessages 765 Epidemiology 765 CaseIntroduction 766 Pathogenesis 767 NormalSagittalProfile 768 Definition and Classification . . 771 ClinicalPresentation 773 History 773 PhysicalFindings 774 DiagnosticWork-up 775 ImagingStudies 775 NeurophysiologicalTests 777 LungFunctionTest 777 DifferentialDiagnosis 777 Non-operativeTreatment 779 NaturalHistory 779 BracingandCasting 780 CaseStudy1 780 OperativeTreatment 782 PreoperativeAssessment 782 GeneralPrinciples 783 OperativeTechnique 784 CaseStudy2 786 ResultsofOperativeTreatment 788 Complications 790 Recapitulation 791 KeyArticles 792 References 793 29 Malformations of the Spinal Cord Dilek Könü-Leblebicioglu, Yasuhiro Yo n e k awa CoreMessages 797 Epidemiology 797 CaseIntroduction 798 Pathogenesis 799 EmbryologicalAspects 799 RelevantEmbryogeneticSteps 800 RiskFactors 801 Pathophysiology of Tethered Cord Syndrome 802 TerminologyandClassification 802 ClassificationofSpinalMalformation 803 XX Contents CaseStudy1 805 ClassificationofTetheredSpinalCord 811 ClinicalPresentation 812 History 812 PhysicalFindings 813 DiagnosticWork-up 814 PrenatalDiagnosis 814 PostnatalDiagnosticTests 815 Treatment 815 InUteroTreatment 816 PostnatalSurgery 816 Recapitulation 818 KeyArticles 819 References 819 Fractures 30 Cervical Spine Injuries Michael Heinzelmann, Karim Eid, Norbert Boos CoreMessages 825 CaseIntroduction 826 Epidemiology 827 Pathomechanisms 828 NormalAnatomy 828 BiomechanicsofCervicalSpineTrauma 830 SpinalCordInjury 832 Pathomechanism of Whiplash-Associated Disorders 833 ClinicalPresentation 834 History 834 PhysicalFindings 835 Classification of Whiplash-Associated Disorders 836 DiagnosticWork-up 836 ImagingStudies 836 Neurophysiology 842 VascularAssessment 842 Synopsis of Assessment Recommendations 842 GeneralTreatmentPrinciples 844 Whiplash-AssociatedDisorders 844 Non-operativeTreatmentModalities 845 SpinalCordInjuries 848 Specific Treatment of Upper Cervical Spine Injuries 850 FracturesoftheOccipitalCondyle 850 Atlanto-occipitalDislocation 851 FracturesoftheAtlas 852 AtlantoaxialInstabilities 853 DensFractures 854 CaseStudy1 858 TraumaticSpondylolisthesisoftheAxis 860 CaseStudy2 862 CombinedAtlas/AxisFractures 863 Classification and Treatment of Subaxial Injuries 863 Classification 864 Treatment 866 CaseStudy3 870 Complications 871 Recapitulation 871 KeyArticles 873 References 874 31 Thoracolumbar Spinal Injuries Michael Heinzelmann, Guido A. Wanner CoreMessages 883 Epidemiology 883 CaseIntroduction 884 Pathomechanisms 885 AxialCompression 885 Flexion/Distraction 886 Hyperextension 886 RotationalInjuries 886 Shear 887 Classification 887 DenisClassification 888 AOClassification 888 ClinicalPresentation 892 SpinalInjuries 892 NeurologicalDeficit 892 ConcomitantNon-spinalInjuries 893 History 893 PhysicalFindings 894 DiagnosticWork-up 895 ImagingStudies 895 Non-operativeTreatment 898 SteroidTreatmentofSpinalCordInjury 899 Non-operativeTreatmentModalities 899 CaseStudy1 900 OperativeTreatment 903 GeneralPrinciples 903 SurgicalTechniques 905 CaseStudy2 906 CaseStudy3 911 Outcome of Operative Versus Non-operative Treatment 914 Recapitulation 918 KeyArticles 919 References 920 32 Osteoporotic Spine Fractures Paul F. Heini, Albrecht Popp CoreMessages 925 Epidemiology 925 CaseIntroduction 926 Pathogenesis and Definition . . 926 Classification of Vertebral Body Compression Fractures 929 Contents XXI ClinicalPresentation 930 History 930 PhysicalFindings 933 DiagnosticWork-up 933 ImagingStudies 933 RadionuclideStudies 934 Densitometry 934 BoneBiopsy 935 LaboratoryInvestigations 935 Non-operativeTreatment 936 ConservativeFractureManagement 936 MedicalTreatment 936 OperativeTreatment 937 GeneralPrinciples 937 SurgicalPrinciples 937 Recapitulation 942 KeyArticles 943 References 944 Tumors and Inflammation 33 Primary Tumors of the Spine Bruno Fuchs, Norbert Boos CoreMessages 951 Epidemiology 951 CaseIntroduction 952 TumorBiology 953 MolecularTumorBiology 953 PathwaysofMetastasis 954 HistologyandBiologyofSpinalTumors 956 ClinicalPresentation 957 History 957 PhysicalFindings 957 DiagnosticWork-up 958 ImagingStudies 958 CaseStudy1 960 CaseStudy2 961 Biopsy 964 LaboratoryInvestigations 964 TumorStaging 964 BenignTumors 965 MalignantTumors 966 Non-operativeTreatment 967 Non-steroidal Anti-inflammatory Drugs . . . 967 AdjuvantTherapy 967 OperativeTreatment 968 GeneralPrinciples 968 SurgicalTechniques 969 CaseStudy3 971 Recapitulation 973 KeyArticles 974 References 974 34 Spinal Metastasis Dante G. Marchesi CoreMessages 977 Epidemiology 977 CaseIntroduction 978 Pathogenesis 978 ClinicalPresentation 980 History 980 PhysicalFindings 980 DiagnosticWork-up 981 ImagingStudies 981 Biopsy 983 LaboratoryInvestigation 983 Classification 984 Non-operativeTreatment 985 Steroids 985 Radiotherapy 985 OperativeTreatment 986 GeneralPrinciples 986 GeneralSurgicalTechniques 987 SpecificSurgicalTechniques 988 CaseStudy1 989 CaseStudy2 992 CaseStudy3 993 PostoperativePatientManagement 993 Recapitulation 994 KeyArticles 995 References 995 35 Intradural Tumors Yashuhiro Yonekawa, Richard Marugg CoreMessages 997 Epidemiology 997 CaseIntroduction 998 EtiologyandPathogenesis 998 ClassificationofIntraduralTumors 999 Intradural-ExtramedullaryTumors 999 DifferentialDiagnosis 1000 CaseStudy1 1001 Intradural-IntramedullaryTumors 1002 CaseStudy2 1004 ClinicalPresentation 1005 History 1005 PhysicalFindings 1006 DiagnosticWork-up 1006 ImagingStudies 1007 LumbarPuncture 1008 Treatment 1009 Non-surgicalTreatment 1009 SurgicalTreatment 1009 SurgicalTechniques 1010 Intrinsic Spinal Cord Tumor Resection . . . . 1012 CaseStudy3 1013 Recapitulation 1016 XXII Contents KeyArticles 1017 References 1018 36 Infections of the Spine Norbert Boos CoreMessages 1021 Epidemiology 1021 CaseIntroduction 1022 Pathogenesis 1023 Classification 1023 ClinicalPresentation 1024 History 1024 PhysicalFindings 1025 DiagnosticWork-up 1025 LabaratoryInvestigations 1025 ImagingStudies 1026 Biopsy 1028 NonoperativeTreatment 1029 CaseStudy1 1030 OperativeTreatment 1031 GeneralPrinciples 1031 SurgicalTechniques 1031 CaseStudy2 1035 Recapitulation 1036 KeyArticles 1037 References 1037 37 Rheumatoid Arthritis Dieter Grob CoreMessages 1041 Epidemiology 1041 Pathogenesis 1041 CaseIntroduction 1042 Classification 1044 ClinicalPresentation 1045 History 1045 PhysicalFindings 1045 DiagnosticWork-up 1045 ImagingStudies 1045 CaseStudy1 1047 InjectionStudies 1048 NeurophysiologicalInvestigations 1048 Non-operativeTreatment 1048 OperativeTreatment 1048 GeneralPrinciples 1048 Indications 1049 SurgicalTechniques 1050 CaseStudy2 1053 Recapitulation 1054 KeyArticles 1054 References 1055 38 Ankylosing Spondylitis Thomas Liebscher, Kan Min, Norbert Boos CoreMessages 1057 Epidemiology 1057 CaseIntroduction 1058 Pathogenesis 1060 ClinicalPresentation 1061 History 1061 PhysicalFindings 1062 DiagnosticWork-up 1063 LaboratoryInvestigations 1063 ImagingStudies 1063 DiagnosticCriteria 1066 Non-operativeTreatment 1067 NaturalHistory 1067 Non-operativeManagement 1068 Physiotherapy 1069 TreatmentRecommendations 1069 OperativeTreatment 1070 GeneralPrinciples 1070 Planning of Osteotomies . . . 1071 SurgicalTechniques 1072 CaseStudy1 1076 CaseStudy2 1078 Complications 1080 Recapitulation 1080 KeyArticles 1081 References 1082 39 Treatment of Postoperative Complications Martin Krismer, Norber t Boos CoreMessages 1087 FrequencyofComplications 1087 CervicalSpineSurgery 1087 CaseIntroduction 1088 AnteriorSpinalSurgery 1089 Disc Herniation and Spinal Stenosis . . . . . . 1089 LumbarSpinalFusion 1090 ComparisonofComplications 1090 PreventiveMeasures 1090 ScreeningofRiskFactors 1091 Preoperative Planning 1093 ProfoundKnowledgeofAnatomy 1094 Patient Positioning . . . 1094 Neuromonitoring 1095 Approach-RelatedComplications 1095 AnteromedialCervicalApproach 1096 CaseStudy1 1097 Anterior Approach to the Cervicothoracic Junction 1098 Thoracotomy 1098 ThoracolumbarApproach 1100 Contents XXIII . 22 1 Reproducibility 22 1 Differential Diagnosis of Spinal Pain Syndromes 22 2 Recapitulation 22 2 KeyArticles 22 3 References 22 4 9 Imaging Studies Marius R. Schmid, Jürg Hodler CoreMessages 22 7 ImagingMethods 22 7 StandardRadiographs. 20 3 Pain 20 4 Function 21 0 SpinalDeformity 21 0 PhysicalExamination 21 1 Walking 21 1 Standing 21 1 Sitting 21 6 LyingSupine 22 0 LyingonLeft/RightSide 22 0 LyingProne 22 1 AbnormalIllnessBehavior 22 1 Reproducibility. Pfirrmann CoreMessages 26 1 RationaleforSpinalInjections 26 1 LumbarandCervicalNerveRootBlocks 26 2 Indications 26 2 Technique 26 3 Complications 26 5 DiagnosticandTherapeuticEfficacy 26 5 EpiduralandCaudalBlocks 26 7 Indications